Psoriasis in Pregnancy: A Review

Main Article Content

Nahla Shihab
Michael Tyutyunik
Mark Lebwohl

Keywords

psoriasis, pregnancy

Abstract

Psoriasis is a complex autoimmune disease, most commonly characterized by silvery scale erythematous plaque. During pregnancy, there is a physiologic change of immunology status, which shifts from an inflammatory state to an anti-inflammatory state, in order to avoid fetal rejection. As a result of this immunomodulatory changes, the majority of pregnant patients experience improvement of their psoriasis. The treatment of psoriasis in pregnancy can be challenging, mainly because there is only a few evidence-based studies. The objective of this paper is to review the relevant data on psoriasis in pregnancy and its treatment.

References

1. Krueger GG, Feldman SR, Camisa C, Duvic M, Elder JT, Gottlieb AB, Koo J, Krueger JG, Lebwohl M, Lowe N, Menter A. Two considerations for patients with psoriasis and their clinicians: What defines mild, moderate, and severe psoriasis? What constitutes a clinically significant improvement when treating psoriasis? Journal of the American Academy of Dermatology. 2000 Aug 1;43(2): 281-5.
2. Feldman SR. Epidemiology, clinical, manifestations, and diagnosis of psoriasis. [Updated 2019 Aug 6]. In: UpToDate [Internet]. Available from: https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-diagnosis-of-psoriasis (accessed 31 October 2019).
3. Lebwohl M, Ting PT, Koo JY. Psoriasis treatment: traditional therapy. Annals of the rheumatic diseases. 2005 Mar 1;64(suppl 2): ii83-6.
4. Janssen NM, Genta MS. The effects of immunosuppressive and anti-inflammatory medications on fertility, pregnancy, and lactation. Archives of internal medicine. 2000 Mar 13;160(5): 610-9.
5.. Ryan S. Psoriasis: characteristics, psychosocial effects and treatment options. British journal of nursing. 2008 Mar 13;17(5): 284-90.
6. Reali E, Brembilla NC. Editorial: Immunology of psoriatis disease.Frontiers in Immunology. 2019 Mar 29;10(657):1-3.
7. Blauvelt A, Ehst B. Patophysiology of plaque psoriasis. [Updated 2019 Apr 30]. In: UpToDate [Internet]. Available from: https://www.uptodate.com/contents/ pathophysiology-of-plaque-psoriasis (accessed 31 October 2019).
8. Robinson, D. P., & Klein, S. L. (2012). Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis. Hormones and behavior, 62(3), 263-271.
9. MacLean MA, Wilson R, Thomson JA, Krishnamurthy S, Walker JJ. Immunological changes in normal pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1992 Feb 28;43(3): 167-72.
10. Hoffman MB, Farhangian M, Feldman S. Psoriasis during pregnancy: characteristics and important management recommendations. Expert Rev. Clin. Immunol. 11(6), 709–720 (2015)
11. Yip L, McCluskey J, Sinclair R. Immunological aspects of pregnancy. Clin Dermatol 2006;24(2):84-7
12. Boyd AS, Morris LF, Phillips CM, et al. Psoriasis and pregnancy: hormone and immune system interaction. Int J Dermatol 1996;35(3):169-72
13. Murase JE, Chan KK, Garite TJ, Cooper DM, Weinstein GD. Hormonal effect on psoriasis in pregnancy and post-partum. Archives of dermatology. 2005 May 1;141(5): 601-6.
14. Nolten WE, Rueckert PA. Elevated free cortisol index in pregnancy: possible regulatory mechanisms. Am J Obstet Gynecol 1981;139(4):492-8
15. Weatherhead S, Robson SC, Reynolds NJ. Management of psoriasis in pregnancy. BMJ. 2007 Jun 7;334(7605): 1218-20.
16. Bae YS, Van Voorhees AS, Hsu S, et al. Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol 2012; 67(3):459-77
17. Dhar S, Seth J, Parikh D. Systemic side-effects of topical corticosteroids. Indian J Dermatol 2014;59(5):460-4
18. Chi CC, Kirtschig G, Aberer W, et al. Evidence-based (S3) guideline on topical corticosteroids in pregnancy. Br J Dermatol. 2011;165(5): 943–952
19. Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol. 2014;70(3):401. e1–e14
20. Vena GA, Cassano N, Bellia G, Colomb\o D. Psoriasis in pregnancy: challenges and solutions. Psoriasis: Targets and Therapy 2015;5:83-95.
21. Lam J, Polifka JE, Dohil MA. Safety of dermatologic drugs used in pregnant patients with psoriasis and other inflammatory skin diseases. J Am Acad Dermatol 2008;59(2):295-315
22. El-Saie LT, Rabie AR, Kamel MI, Seddeik AK, Elsaie ML. Effect of narrowband ultraviolet B phototherapy on serum folic acid levels in patients with psoriasis. Lasers Med Sci. 2011;26(4):481–485.
23. Emer JJ, Frankel A, Zeichner JA. A practical approach to monitoring patients on biological agents for the treatment of psoriasis. The Journal of clinical and aesthetic dermatology. 2010 Aug;3(8): 20.
24. Story, C.M. A major histocompatibility complex class I-like Fc receptor cloned from human placenta: Possible role in transfer of immunoglobulin G from mother to fetus. J. Exp. Med. 1994, 180, 2377–81
25. Porter ML, Lockwood SJ, Kimball AB. Update on biologic safety for patients with psoriasis during pregnancy. Int J Womens Dermatol 2017;3:21–5.
26. European Medicines Agency. Certolizumab pegol (Cimzia) summary of product characteristics [Internet]. [cited 2019 November 8]. Available from: https://www. ema.europa.eu/en/documents/product-information/cimzia-epar-productinformation_en.pdf; 2019.
27. Watson N, Wu K, Farr P, Reynolds NJ, Hampton PJ. Ustekinumab exposure during conception and pregnancy in patients with chronic plaque psoriasis: a case series of 10 pregnancies. Br J Dermatol. 2018;180(1):195-6.